PROSTATE CANCER: PET/MRI to avoid 80% of unnecessary biopsies

Thus, PET/MRI can improve the diagnostic accuracy of patients with prostate cancer and avoid unnecessary invasive tests, but only if the correct scale is used.

The Prostate Imaging Reporting and Data System (PI-RADS) is a 5-point scale used to evaluate suspected prostate cancer on MRI images. PI-RADS category 3, which represents an unclear suggestion of clinically significant prostate cancer, remains a “diagnostic challenge.” Although current guidelines recommend biopsy in this situation, less than 20% of lesions classified as PI-RADS 3 correspond to clinically significant prostate cancer.

Diagnostic Solution to the Lesion Dilemma PI-RADS 3

“PI-RADS 3 lesions present a dilemma for both urologists and patients because immediate biopsy is often not required; however, an active surveillance strategy may also result in missed diagnosis of clinically significant prostate cancer.”– summarizes one of the lead authors, Dr. Hongqian Guo, a urologist at Nanjing Hospital: “Therefore, specifically excluding prostate cancer from PI-RADS 3 lesions has significant clinical implications. »

Studying performed in 56 men with PI-RADS 3 lesions who underwent 68Ga-PSMA PET/MRI. After imaging, all patients underwent prostate biopsy to assess whether they had clinically significant prostate cancer. These surveys show that:

clinically significant prostate cancer was detected by biopsy in 8 of 56 patients, or 14% of participants;
with PET/MRI, 40 of 48 participants, or 83%, could have avoided unnecessary biopsies, at risk of missing 1 clinically significant prostate cancer in 8 biopsy-detected cancers, or approximately 12%.

The researchers conclude that the “additive value » 68Ga-PSMA PET/MRI in the PI-RADS 3 lesion classification and suggest that in the future, to the extent possible, patients with “PI-RADS 3” should be referred to